Yet another in a long line of inadvertent integrative medicine propaganda articles

Over the last two decades, quackery has been slowly but steadily infiltrating conventional scientific medicine. It began in earnest back in the 1990s, but the groundwork had been laid for at least a couple of decades before, going back to when traditional Chinese medicine made its first foray into the “West.” Unfortunately, over the last couple of decades, the pace of infiltration as accelerated, with the foundation of an NIH center dedicated to studying and promoting quackery and the increasing number of departments and institutes of quackademic medicine. Basically, quackery became alternative medicine, which then became “complementary and alternative medicine, which has now morphed into “integrative medicine,” a term intended imply combining the “best of both worlds” but that really means integrating quackery with medicine.

Unfortunately, what that also means is that the message finds its way into the mainstream press. When a message is so pervasive that it starts to be come normal and accepted. How else can I explain the fawning interview with Heather Greenlee by Karen Weintraub over at Stat, which normally sets a higher standard. I mean, Stat has Carl Zimmer, Ed Silverman, and Sharon Begley. Although I must admit that I’m not a regular reader, I have seen enough there without seeing anything resembling apologetics for quackery that this surprised me when I saw it. Clearly, Weintraub is not familiar with the language of “complementary and alternative medicine” (CAM) or “integrative” medicine. She should have been. A naturopath with an MPH degree as well, Greenlee is a rising star in the world of integrative medicine. She was even the first author on the Society for Integrative Oncology’s guidelines for the “complementary” treatment of breast cancer. Heather Greenlee dishes it up in abundance, which makes this interview a suitable topic for me.

For generations, people with cancer were treated solely for their tumor — not for the pain and other symptoms that came with it. So patients quietly turned to alternative and complementary therapies, outside the halls of medicine.

Now, researchers like Heather Greenlee, an assistant professor of epidemiology at Columbia University’s Mailman School of Public Health, are trying to bring those two approaches into harmony.

Ah, harmony? The “integration” of the best of both worlds, of “Eastern” medicine and “Western” medicine, of hardcore science and touchy feely needs of the patient, of science-based medicine and quackery. Oh, wait. Greenlee didn’t say that. It’s what she meant, though, whether she realizes it or not or whether she’d ever admit it or not. Of course, practitioners like Greenlee are true believers Also note the narrative: That nasty, cold, unfeeling “Western” medicine doesn’t care about the “whole person” and therefore doesn’t treat the whole person. To those nasty, white coated reductionist doctors in their ivory towers, patients aren’t people; they’re just diseases that need to be cured. Cancer patients are just tumors, and as long as the tumor is shrinking doctors don’t care about anything else. At least, so goes the “integrative medicine” narrative, and Greenlee is laying it down perfectly. The reason that the narrative resonates is that there is a grain of truth there. Certainly the system can be impersonal at times, and, as is the case with any profession, there are sometimes doctors who are not very caring. However, the narrative peddled by integrative medicine is just what Greenlee is peddling: That cancer doctors never cared much about their patients; they just treated their cancer.

It’s a narrative that is pure bullshit that takes a small core of truth and ladles on the nonsense. It takes one bad experience or a handful of experiences and generalizes it:

What inspired you to go into this area of research?

My stepfather was diagnosed with a brain tumor when I was pretty young. I quickly saw where the medical system failed him. Seeing how our whole family really suffered through that, I thought there was a lot of room for improvement.

Again, no one is denying that the medical system has problems, that it’s imperfect. However, the answer to those imperfections is not to compromise the scientific basis of medicine by integrating quackery with it. Just because modern medicine might not always be as caring as patients would like it to be does not mean that the solution to this coldness is to embrace warm quackery.

Then, of course, there is the rebranding:

Are there things cancer patients can do that might reduce their risk of a recurrence?

I try! It’s better for cardiovascular disease and diabetes prevention. Also, I just feel better.

One more time, there is nothing “integrative” about any of these. All of these dietary interventions are potentially science-based measures. Of course, although there is evidence supporting that certain diets can decrease the risk of developing specific cancers. In contrast, the evidence that diet can decrease the risk of recurrence after successful initial treatment for cancer. It’s worth studying whether diet can do that, but, again, there’s nothing “alternative” or “integrative” about such studies. They’re just science and medicine. That’s why practitioners like Greenlee co-opt and rebrand interventions like diet and exercise as integrative medicine when they are just medicine, or at least potentially medicine if they work.

Indeed, here’s the problem with integrative medicine. Actually it’s just one of many. Arguably, associating such interventions with quackery like acupuncture, energy medicine, and the other pseudoscience that integrative medicine integrates with medicine does advocates of diet as promoting health and preventing disease no favors. As a marketing ploy, lumping diet and exercise together with the other quackery is a coup, because the fact that these modalities are lumped together allows the plausibility and potential efficacy of science-based diet and lifestyle interventions rub off on the quackery. The flip side of that is that the quackery also taints diet and lifestyle interventions, which have, unfortunately, in integrative medicine become the bailiwick of quacks.

Along with this:

What are the most effective complementary therapies?

There’s a lot of strong evidence on the use of mind-body therapies for things like stress management, anxiety, depression. And there’s a growing body of evidence on acupuncture for pain management.

As I’ve discussed before, “mind-body” is a term that’s so vague, so undefined, as to be almost meaningless. Heck, these days the NCCIH basically calls everything that isn’t herbal medicine “mind-body” interventions. I’ve discussed on more occasions than I can remember why acupuncture is quackery, nothing more than a theatrical placebo, a description used by David Colquhoun and Steve Novella that I wish I had thought of. Yet integrative medicine sure does love it some acupuncture, and the rest of traditional Chinese medicine, even though it’s based on a vitalistic, prescientific belief system about how the human body works.

Here’s a part that I found particularly telling:

How do you personally hope to change integrative medicine?

Historically, integrative therapies have been only available to people who were wealthy. If these are really beneficial therapies that have low toxicity, we want to get them to everybody.

Yes, integrative medical specialists are evangelists, but they never seem to ask themselves why such “therapies” were only available to the well-off. That’s because many of them were expensive, but, more importantly, most of them weren’t covered by health insurance. The reason, of course, is that most of these modalities have little or no evidence that they work, and some even have evidence that they don’t work. As I like to say, to paraphrase a famous aphorism, there are three kinds of medicine: Medicine that’s been scientifically demonstrated to work, medicine that has not been demonstrated to work, and medicine that’s been demonstrated not to work. Alternative medicine that’s being “integrated” into integrative medicine largely falls into the latter two categories. Again, there’s no need for a separate category. Alternative medicine that is scientifically demonstrated to work ceases to be “alternative” and become just medicine, no need for any additional qualifier like “integrative.” I’ll give Greenlee credit for recognizing that there’s a lot of quackery out there, but just like Barrie Cassileth, she seems unable to recognize that a lot of similar quackery.

Basically, Heather Greenlee laid down a whole lot of integrative medicine propaganda. I’ve heard it all before, as have regular readers of this blog. Apparently Weintraub didn’t, because she fell for it, hook, line, and sinker.

51 Comments

IMHO, quackery has always been there. The thing is that it has no achievement that stand the test of time. And, some of them, like homeopathy, survive despite lack of efficiency. I think the problem of today is the number of people getting degrees.

My grandmother fried meat – in lard and bacon fat. They went with the potatoes, smothered in butter or in poorer times, oleo.
Of course, we also ate a lot of sauerkraut, so perhaps that was an antidote for all the meat and fat. Vegetables outside of the growing season, were always canned. Nothing tastes quite like pie crust made from lard.

Grandma’s “go to” for my afterschool or any other time snacks, were “sandwich cookies” made from graham crackers and lots of lovely buttercream frosting. I used to make them for my own children – you know, cooking like my grandmother did.

The Quacks always label everything “Mind-Body” because it protects them from failure. They can just (reprehensively) blame the patient if the quack treatment does not work. “You just have to believe more!”

It feels difficulty to push back the influx (as in a toilet overflowing turds that won’t stop) of CAM quackery when you see groups like the AAP issue reports like this on CAM ( http://www.medscape.org/viewarticle/584824 ) :

“The present AAP clinical report describes CAM services, current levels of utilization and costs, and related legal and ethical issues. Given the breadth and range of CAM, the task force concluded that an in-depth review of each modality was beyond the scope of this report.

The aims of the report were therefore to define terms; to review the epidemiology; to list frequently used CAM modalities; to discuss medicolegal, ethical, and research implications; to describe education and training for CAM providers; to offer resources for additional learning regarding CAM; and to suggest communication strategies that clinicians may find helpful when discussing CAM with patients and families.

Now that many CAM modalities, such as guided imagery and massage for pain treatment, have been formally tested and integrated into standard practice, the distinction between CAM and mainstream medicine has become less apparent. The terms holistic medicine or integrative medicine is being increasingly substituted for CAM….

A common-sense approach to advising families regarding use of CAM modalities is that those treatments shown to be safe and effective should be encouraged, those treatments that are safe but ineffective may be tolerated, those modalities that are effective but raise safety issues should be closely monitored or discouraged, and those therapies that are neither safe nor effective should be discouraged.

For patients being treated by a CAM provider, the pediatrician should seek permission of the patient and family to include the CAM provider in the overall management plan.”

What they call a “common sense approach” is not common sense at all. As you note if a CAM thing is safe and effective, it’s not really CAM anymore–it’s medicine. If a CAM thing is not effective or not safe, it should be opposed by the physician. And, of course, there’s still the issue that a lot of CAM claimed as “safe and effective” is based on papers of rather poor quality. at best.

I can’t but wonder how dietitians are reacting to essentially being categorized as woo. Maybe they’re fatigued by constantly being mistaken for/lumped together with nutritionists and this is just par for the course…

# 14 Science Mom
I have the impression my father’s parents, at least in winter time, lived on salt pork, potatoes and other root vegetables with preserved (home-canning) fruits for desert. Rural Canada, pre-WWI.

My father did not like (err,. detested?) pork for the rest of his life.

Some of the those 1950’s and 60’s meals would have looked pretty good to dad.

@Renate: Yes, many of the woo pushers are being historically revisionist in pushing this East-West dichotomy.

In China there is an explicit dichotomy between zhong (“traditional” Chinese) and xi (“Western”, or science-based) medicine. Mao deserves much of the blame for the rise of zhong medicine worldwide, but at least he was trying to bring some kind of medicine to the people, at a time when China did not have the resources to deploy xi medicine (which Mao himself always preferred–he wasn’t stupid) on any kind of large scale–quite the opposite of today’s woo pushers, who (as Greenlee herself implicitly admits) tend to go where the money is. And “traditional” Chinese remedies at least allegedly contain theraputic amounts of the alleged active ingredient (there are fake traditional Chinese medicines out there, which is a separate issue). They don’t dilute beyond Avogadro’s number the way homeopaths routinely do.

The old mind-body gambit, that it’s a novel idea that the mind is integrated with the body.
Something medical science realized when it was noticed that not only is the head firmly attached to the body, but nerves and blood vessels run to and from the brain and endocrine glands in the brain. That what impacts the body also impacts the mind and vice versa quite often.
The quacks will hope that none discover the ancient concept and phenomena “psychogenic shock”, which acknowledges that when one’s mind isn’t prepared for an experience psychologically, one’s blood pressure can plummet.
Like when Bob the medic carelessly places a traumatically amputated arm on the litter with the amputee, who then recognizes his wristwatch on the anatomically inconsistently located wrist.
Don’t laugh, it’s happened and what should have been a fainting spell turned into some real work, as the patient also had significant blood loss.
Or that mental wards frequently test thyroid hormone levels, as hyperthyroidism can cause mental illness or make preexisting subclinical mental illness severe.
The body also has its own intelligence (work with me on this one, in a very real way, it’s true), as it’s really good at operating the entire GI tract, regardless of what is input (well, largely) and efficiently process food. It’s brilliant, even if it’s about as bright as a worm. Quacks make much of the enteric nervous system, largely because of the quip of “the second brain”, which are really just a bunch of ganglia networked together. The reality is simpler and more complex, a brain it ain’t, as bright as a worm, well, a bit brighter – only a bit, it doesn’t think, plan, plot, have goals to accomplish, it manages digestion and has inputs from the sympathetic and parasympathetic nervous system. The advantage is simple enough, animals don’t have to have that big brain micromanage the digestive tract, but slowing it down in times of emergency is important, as is getting feedback from it when one eats the wrong thing. No magic, just managing moisture and peristalsis.
The quacks see all manner of nonsense on top of that. Trust me, I ran into a wall of word salad attempting to mis-describe the enteric nervous system just last week.
Real medicine doesn’t need to use mind-body, as it recognizes that the body and mind are integrated, not via woo, but via two branches of the central nervous system and the endocrine system. Woo peddlers then take that and turn it into magic, rather than the rather well established science, seeing links where there are none and using a few well established concepts and abusing them into woo.
Hence, why I told a woo master to stuff his kale and kelp, when I mentioned hyperthyroidism. Yes, a large dose of iodine is useful for a medical professional, but an uncontrolled, mid-treatment administration could cause severe problems, very severe problems.

I have a friend undergoing chemo for breast cancer. Every treatment, her white cell count has tanked and she ends up in the hospital. The second time it happened, her oncologist (her ONCOLOGIST!) went and bought her a milkshake. She would now kill for him. Maybe the system is impersonal, but the vast majority of the people aren’t. I’ll take science-based medicine and nice people for the win (and so will she.)

Medicine that’s been scientifically demonstrated to work,
tell that to those injured or killed by withdrawn FDA approved drugs

and medicine that’s been demonstrated not to work
a category filled with hired guns and fraudulent or poorly founded, adversarial presentations that studiously avoid successful regimens and algorithms.

@prn, #24: Personally, I admit to sparing my mind from the anguish of reading anecdotal accounts of supposedly successful regimens and prefer to wait for well controlled trials of sufficient size and number before deciding they merit attention. As for those scientifically demonstrated to work, but that were subsequently found to harm or kill, we can thank science-based medicine for uncovering the facts before more patients were harmed.

Why does Greenlee have an MPH? Aren’t naturopaths all about the individual? Because public health is really all about the population.
It’s like the acupuncturists in my MPH program: why are you here? You can’t acupuncture the whole community! There’s no population-level acupuncture.

JustaTech: Sure you can. You can stick needles into a map or an aerial photo. Or you can fire flechette rounds at the entire community. That would be just as effective as traditional acupuncture. In fact, flechettes would be superior in that they would have an objective, measurable effect.
Actually, an MPH ought to have steered her away from woo. If ancient Chinese or Indian medicine was so great, why have India and China had epidemics down to this day?
prn: You’re back to what our gracious host refers to as the flying carpet fallacy. Yes, FDA-approved medications sometimes harm people, and as Lighthorse points out, it’s science-based medicine that catches it. I could turn the question around on you in three ways: How many medications have been correctly found to be dangerous by alties before reality-based medicine did? How many people have suffered harm or died because they were chasing unicorns and martlets instead of getting real treatment? How many have suffered and died because of such dangerous alternative “treatments” as pennyroyal and aristolochia, or from contaminants such as heavy metals or powerful pharmaceuticals that are not disclosed and aren’t supposed to be there anyway?

My dad (when discussing how things have changed) would tell the story of eating with his grandparents. They complained about the pork chops – that didn’t have enough fat on them.

Another example of how times have changed – he said it was common for him and his friends to bring a rifle and a pocket full of shells to school – there were squirrels on the way home that needed to be shot for dinner.

# 27 shay simmons
1/3 buttter to 1/3 lard. Humm there may be an apple pie in the near future.

# 30 Johnny
We never did that. We didn’t eat squirrels.
On the other hand I remember smuggling a 22 rifle and a few blanks into school once to use as a prop in a pantomime. The teacher thought it was a great idea.

The best thing is I have the .22 dad took to school – a Remington model 12. It’s mostly shot out, it’s almost a smooth bore, but it’s the first real gun I ever shot.

I also have those same great grandparents shotgun. It’s a break open single shot, and was kept by the kitchen door ‘in case the hawks got after the chickens’. It’s an old, worn out, inexpensive sort of gun, the kind you could buy dozens of for less than $50, and the last one that I’d ever sell.

Most people will tell you that Colts and Winchesters were the guns that won the west. But single shot shotguns were what enabled farmers to hold on to a piece of land and make it profitable (where profit = survival).

a category filled with hired guns and fraudulent or poorly founded, adversarial presentations that studiously avoid successful regimens and algorithms.

I would agree on the fraudulent part.
But maybe not the way you meant it.

“algorithms”.
That’s these “algorithms”, anyway?
The click-bait ads in my e-mail box have been telling me for months that my country is about to be invaded by “algorithms”.
I would like to know if I should make room for them in the guest bedroom or fetch my shotgun.

My father grew up on a farm in the 1930’s-1940’s and, everytime I hear someone extolling the virtues of old fashioned “clean eating”, I chuckle. According to them, you can’t get any “cleaner” than growing your own food and eating it.

But, wait! My grandmother’s kitchen was full-fat: butter, cream, milk, lard, you name it, she used made it and used it. The fat was necessary when your husband and children were doing hard labour in the fields from dawn ’til dusk. Some of the produce grown was eaten fresh, but the surplus was processed: canned or pickled. Same with meat; what couldn’t be eaten right away was smoked, cured, pickled or salted down. Fruit was canned, sugared or pickled. Same with eggs. And when my father and his brothers went fishing, that surplus was pickled or salted, as well.

Nothing was wasted, not even blood (blood sausage, anyone?) To his dying day, my father adored blood sausage. Mind you, he also loved liver, fried calf’s brains, baked kidneys, stuffed heart and sweatbreads (shudder), as well, none of which have EVER crossed my threshold and never will.

So, between the fat, salt, and smoking – not to mention processing – that predominated in my grandmother’s kitchen, I am always amused when I hear the stories about how “clean” and “pure” the food was in my grandparent’s day.

My grandmother had a big metal canister on her stove with a strainer that fit over the lid. When we fried bacon for breakfast, we strained the grease into the canister. When we needed grease to fry something or as a starter for gravy, we took some bacon grease out of the canister. But we didn’t put sausage grease into it, because it would go bad.

But when we made pies or biscuits or fried chicken, we used Crisco.

The state cookie of New Mexico is the bizcochito. You can make them with butter or shortening, but they don’t get the right texture unless you use lard.

When we fried bacon for breakfast, we strained the grease into the canister. When we needed grease to fry something or as a starter for gravy, we took some bacon grease out of the canister.

My friend Andy went through a phase in college where he was saving up bacon grease to use for cooking, and keeping it in the fridge. He was living in a big co-op type house at the time, and one of his roommates threw it out because it was “blocking the chi in the kitchen.” Oh, Olympia.

My (first cousin once removed?) Helen once divulged the secret to her peanut butter cookies, which was to use bacon grease as the cooking fat instead of butter or whatever else. They were really good.

[email protected] #25:…As for those [drugs] scientifically demonstrated to work, but that were subsequently found to harm or kill, we can thank science-based medicine for uncovering the facts before more patients were harmed.
RODave …it’s science-based medicine that catches it…How many medications have been correctly found to be dangerous by alties before reality-based medicine did?
I would credit the victims (or surviving family) and lawyers for more often uncovering bad drugs. Institutional SBM seems more often in the CYA rearguard, belatedly confirming, as belatedly as possible, rather than being the vanguard of problem drug discovery.
e.g. Equine estrogens were long, long criticized by alt med.

[email protected]How many have suffered and died because of such dangerous alternative “treatments” as pennyroyal and aristolochia, or from contaminants such as heavy metals or powerful pharmaceuticals that are not disclosed and aren’t supposed to be there anyway?How many people have suffered harm or died because they were chasing unicorns and martlets instead of getting real treatment?

Dunno. I view much here at RI as the flip side of these people doing the dangerous tx, same coin. Members from both groups appear to suffer a lack of insight and discernment for effectiveness in areas of sparse data. The primary difference is that the “scientifically unwashed” CAM pts may swallow almost anything whereas RI indiscriminately damns everything, including stuff that works pretty easily.

That is an interesting observation. Do you have any specific examples of stuff that works pretty easily yet has been indiscriminately damned by the Respectful Insolence mob?

As an aside, the idea that lawyers are engaged in keeping the drug supply safe is laughably irresponsible. In this instance the ambulance chasers are engaged in the highly profitable business of using the courts to squeeze large pots of cash from what ever sources they can nail. As to families of people with adverse reactions, that is Phase IV clinical trials which collectively are a vitally important part of the system. All the regulars here are aware of the potential existence of serious-but-rare side effects and the various ways that we deal with that reality, but most civilians out in the world have no idea.

For instance, consider a drug that works very well at curing its disease but has a fatal side effect for one patient in a million. That is not likely to be detected in drug trials of fifty thousand subjects, but in the end it will be detected when prescribed thirty million times a year.

You and your lawyer buddies will scream bloody murder to paint doctors as malicious and the FDA as incompetent, but is it really worth it to allow (let us say) thirty thousand people to die every year from the underlying disease in order to protect thirty people from dying of the side effect?

Those are the real kinds of issues that have to be balanced in managing an actual medical supply system, as opposed to the fantasy medical supply systems in which roadside herbs cure cancer while evil doctors and their greedhead pharmacy pals deliberately poison the innocent for Big Bucks.

I have never had calf’s brain but everything else sounds fine. I think, though, I prefer the kidneys fried for breakfast. Next thing I know you will be turning up your nose at a nice sautéed grasshopper. I recommend a slight dusting of chili powder.

Re bacon grease, we never saved it at home but I worked in a college kitchen many, many, years ago and bacon grease was all we used on the flattop grill for things like fried eggs or a snitzel.

# 27 shay simmons

The 1/3 butter, 2/3 lard pastry combination worked out well except for the possible effect on my waistline.

And for real fun have a look at the knock-down, drag-out fight going on over at the BMJ over Nina Teicholz’s commissioned article http://www.bmj.com/content/351/bmj.h4962. Reporter challenges august academic nutritionists over food guidelines. Hysteria prevails. (Note we’re not talking nutcases nutritionists.)